---
type: claim
domain: health
description: "Despite decades of effective generic antihypertensives, BP control rates among treated patients reached only 23.4% in 2021-2023, and simultaneous control of hypertension, diabetes, and hyperlipidemia never exceeded 30% from 1999-2023"
confidence: proven
source: JACC longitudinal study 1999-2023, NHANES nationally representative data
created: 2026-03-30
attribution:
  extractor:
    - handle: "vida"
  sourcer:
    - handle: "jacc-study-authors"
      context: "JACC longitudinal study 1999-2023, NHANES nationally representative data"
supports:
- hypertension-related-cvd-mortality-doubled-2000-2023-despite-available-treatment-indicating-behavioral-sdoh-failure
- US hypertension-related cardiovascular mortality nearly doubled from 2000 to 2019 while treatment and control rates stagnated for 15 years demonstrating structural access failure not drug unavailability
reweave_edges:
- hypertension-related-cvd-mortality-doubled-2000-2023-despite-available-treatment-indicating-behavioral-sdoh-failure|supports|2026-03-31
- food-as-medicine-interventions-produce-clinically-significant-improvements-during-active-delivery-but-benefits-fully-revert-when-structural-food-environment-support-is-removed|related|2026-04-03
- generic-digital-health-deployment-reproduces-existing-disparities-by-disproportionately-benefiting-higher-income-users-despite-nominal-technology-access-equity|related|2026-04-03
- US hypertension-related cardiovascular mortality nearly doubled from 2000 to 2019 while treatment and control rates stagnated for 15 years demonstrating structural access failure not drug unavailability|supports|2026-04-10
related:
- food-as-medicine-interventions-produce-clinically-significant-improvements-during-active-delivery-but-benefits-fully-revert-when-structural-food-environment-support-is-removed
- generic-digital-health-deployment-reproduces-existing-disparities-by-disproportionately-benefiting-higher-income-users-despite-nominal-technology-access-equity
---

# Only 23 percent of treated US hypertensives achieve blood pressure control demonstrating pharmacological availability is not the binding constraint in cardiometabolic disease management

The JACC study tracking 1999-2023 NHANES data reveals a striking failure mode in US cardiometabolic disease management. Among patients already receiving treatment for hypertension, only 23.4% (95% CI: 21.5%-25.2%) achieved blood pressure control by 2021-2023 criteria. More dramatically, the proportion of individuals with all three conditions (hypertension, diabetes, hyperlipidemia) achieving simultaneous control never exceeded 30% at any point during the 24-year study period, despite all three conditions having effective, affordable generic medications available throughout this timeframe (antihypertensives since 1980s, statins since late 1990s, metformin since decades prior). The study explicitly notes that 'treatment and control of these conditions improved during the 2000s, but progress has plateaued in subsequent years,' indicating this is not a problem of insufficient time for diffusion. This 76.6% treatment failure rate among patients already prescribed medication demonstrates that the binding constraint is not drug availability, efficacy, or cost, but rather the behavioral, social, and structural factors that determine medication adherence, lifestyle modification, and care continuity. The plateau in control rates despite continued awareness campaigns and clinical guideline updates suggests these non-pharmacological barriers are not being addressed by the current healthcare delivery model.

---

### Additional Evidence (extend)
*Source: 2026-03-30-jacc-cvd-mortality-trends-1999-2023 | Added: 2026-03-30*

The population-level outcome of poor blood pressure control manifests as doubled hypertensive disease mortality 2000-2023, with 664,000 deaths in 2023 where hypertension was primary or contributing cause. Middle-aged adults (35-64) showed the most pronounced increases, indicating the treatment failure compounds over working-age years.

### Additional Evidence (challenge)
*Source: [[2024-09-xx-pmc-equity-digital-health-rpm-wearables-underserved-communities]] | Added: 2026-03-31*

Digital health is frequently proposed as a solution to the hypertension control failure, but Adepoju et al. (2024) show that generic RPM deployment reproduces existing disparities. Despite high smartphone ownership in underserved populations, medical app usage was significantly lower among those with income below $35,000 and education below bachelor's degree. Barriers included data plan costs, poor connectivity, health literacy gaps, and transportation requirements for onboarding—meaning RPM requires the same access infrastructure it's supposed to bypass. The Affordability Connectivity Program that subsidized broadband for low-income households was discontinued June 2024, removing the primary federal mitigation.

### Additional Evidence (extend)
*Source: [[2024-06-xx-aha-hypertension-sdoh-systematic-review-57-studies]] | Added: 2026-03-31*

The systematic review establishes that the binding constraints are SDOH-mediated: housing instability affects treatment adherence, transportation barriers prevent care access, food insecurity directly increases hypertension prevalence, and insurance gaps reduce BP control. The review endorses CMS's HRSN screening tool (housing, food, transportation, utilities, safety) as a necessary hypertension care component.

### Additional Evidence (confirm)
*Source: [[2025-11-10-statnews-aha-food-is-medicine-bp-reverts-to-baseline-juraschek]] | Added: 2026-04-01*

Boston food-as-medicine RCT achieved BP improvement during active 12-week intervention but complete reversion to baseline 6 months post-program, confirming that the binding constraint is structural food environment, not medication availability or patient knowledge. Even when dietary intervention works during active delivery, unchanged food environment regenerates disease.

### Additional Evidence (confirm)
*Source: [[2026-01-21-aha-2026-heart-disease-stroke-statistics-update]] | Added: 2026-04-03*

The AHA 2026 report notes that 1 in 3 US adults has hypertension and hypertension control rates have worsened since 2015, occurring simultaneously with hypertensive disease mortality doubling. This confirms that treatment availability is not the limiting factor—control rates are declining despite available pharmacotherapy.






Relevant Notes:
- [[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm]]
- [[SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent and no operational infrastructure connects screening to action]]

Topics:
- [[_map]]